I have been seeing a specialist for 7-8 years. They are technically out-of-network but are billed in-network with an authorization. I usually have to get an authorization from the insurance company and usually isn’t an issue. Now they are denying it and claiming there is a provider in-network that I can see now and won’t approve the non-network provider. My primary care doctor has always sent in the authorization and essentially said “we need to keep you going to this specialist at all cost”. Obviously, insurance is insurance and they “have the final say” but is there anything I can do?
My insurance is employer funded. My company I work for has 2000 employees.
I do have out of network coverage but at 3x the price.
I live in Iowa but go to Minnesota for my Specialist. The new one insurance says they will pay for is in Iowa.
My specialist doctor and my primary care doctor highly recommend me not moving my care to a different program. I have had unique testing done and studies done that would essentially stop all that in it’s tracks.
The different program is definitely inferior than the one I have been going to.
I have just started the process for them to change their mind but certain things I can try to do are these:
-talk to my employer HR see what they can do -get a letter from my specialist -talk to my boss for a raise that will cover the out of network difference. -talk to the new specialist and essentially asked for them to say they don’t recommend me moving my care
Anything else I can do?
submitted by /u/foxfor6
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I have been seeing a specialist for 7-8 years. They are technically out-of-network but are billed in-network with an authorization. I usually have to get an authorization from the insurance company and usually isn’t an issue. Now they are denying it and claiming there is a provider in-network that I can see now and won’t approve the non-network provider. My primary care doctor has always sent in the authorization and essentially said “we need to keep you going to this specialist at all cost”. Obviously, insurance is insurance and they “have the final say” but is there anything I can do? My insurance is employer funded. My company I work for has 2000 employees. I do have out of network coverage but at 3x the price. I live in Iowa but go to Minnesota for my Specialist. The new one insurance says they will pay for is in Iowa. My specialist doctor and my primary care doctor highly recommend me not moving my care to a different program. I have had unique testing done and studies done that would essentially stop all that in it’s tracks. The different program is definitely inferior than the one I have been going to. I have just started the process for them to change their mind but certain things I can try to do are these: -talk to my employer HR see what they can do -get a letter from my specialist -talk to my boss for a raise that will cover the out of network difference. -talk to the new specialist and essentially asked for them to say they don’t recommend me moving my care Anything else I can do?
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